Treatment of Unstable Scaphoid Nonunion Using a Volar Locking Plate

Young Woo Kwon; Ji Hun Park; In Cheul Choi; Jae Jun Nam; Jong Woong Park

doi:10.12790/ahm.2019.24.4.311

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Kwon, Park, Choi, Nam, and Park: Treatment of Unstable Scaphoid Nonunion Using a Volar Locking Plate

Hand

Archives of Hand and Microsurgery 2019; 24(4): 311-320.

Published online: 29 November 2019

DOI: https://doi.org/10.12790/ahm.2019.24.4.311

Treatment of Unstable Scaphoid Nonunion Using a Volar Locking Plate

Young Woo Kwon¹, Ji Hun Park², In Cheul Choi¹, Jae Jun Nam¹, Jong Woong Park¹

¹Department of Orthopaedic Surgery, Korea University Anam Hospital, Seoul, Korea.

²Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Korea.

Corresponding author: Jong Woong Park. Department of Orthopaedic Surgery, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Korea. TEL: +82-2-920-5924, FAX: +82-2-924-2471, ospark@korea.ac.kr

Received 26 August 2019 Revised 9 October 2019 Accepted 16 October 2019

Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study is to assess the results of treatment of unstable scaphoid nonunion using a wedge iliac crest bone graft and a volar locking plate and screw system.

Methods

Seventeen patients are included in the study and the average age was 30.4 years. The mean duration of non-union was 44.8 months. All patients underwent open reduction, wedge-bone grafting from the iliac crest, and internal fixation using a 1.5 mm volar locking plate and screw. The nonunion sites were scaphoid waist in 12 patients and proximal pole in 5 patients. The mean follow up periods after the operation was 10.2 months. The mean union time was determined with plain radiographs and computed tomography scan. At final follow-up, range of motion (ROM) of the wrist, scapholunate and radiolunate angles, and height-to-length ratio were measured.

Results

All 17 scaphoids united in a mean time of 7.9 weeks after operation. Both scapholunate angle and radiolunate angles are recovered within the normal range. The average extension-flexion arc of the injured wrists was 127.9 degrees, which was improved over 34% of preoperative ROM. Pro- and supination were normal. There was no hardware related problems and no plate removal was necessary during the follow-up period.

Conclusion

The use of an anatomical 1.5 mm volar locking plate with an anterior wedge iliac bone graft provides optimal stability for the unstable scaphoid nonunion. The rapid union after the plate fixation allowed earlier rehabilitation without cast immobilization which is usually performed with other fixation methods.

Keywords: Scaphoid, Nonunion, Wedge bone graft, Locking plate

Figures and Tables

Fig. 1

Burring sclerotic fracture margin and cystic portion and check punctuate bleeding.

Fig. 2

Reduction and temporary K-wire fixation then wedge structural bone graft is inserted.

Fig. 3

Plate positioning and locking screw are inserted.

Fig. 4

Ensure proper screw length with various radiographic views.

Fig. 5

Representative case of a scaphoid waist nonunion in a 20-year-old patient with humpback deformity. (A) Preoperative radiographs and computed tomography (CT) scan in the long axis of the scaphoid. (B) Postoperative radiographs and CT scan in the long axis of the scaphoid at 8 weeks follow-up demonstrating union of scaphoid and correction of the deformity.

Fig. 6

(A, B) Plain radiographs and (C) illustrations of pre-contoured 1.5 mm volar plate fixed in the scaphoid after anterior wedge bone graft.

Fig. 7

Proximal scaphoid watershed line (PSWL) is the point at which the nonarticulating portion of scaphoid bone becomes articulating.

Table 1

Treatment classification system for scaphoid nonunions

Cited from the article of Slade and Dodds (Clin Orthop Relat Res. 2006;445:108–19)7.

Table 2

Demographics and selective results of patients

M: male, F: female, L: left, R: right, IV: cyst formation and sclerosis, V: cyst formation and sclerosis, VI: pseudarthrosis, a: proximal pole nonunion, b: avascular necrosis.

Table 3

Radiologic outcome in the patients

Table 4

Clinical outcome in the patients

DASH: disabilities of the arm, shoulder, and hand, VAS: visual analogue scale, -: not available.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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